| NPI | 1639876139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS50431) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 122628) |
| 183500000X Pharmacist (Licence: UT 9027449-1701) | |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2023-02-14 |